FORM 1023-EZ for PHYSICIANS WORKING TOGETHER INCORPORATED
| Field | Data |
|---|---|
| EIN | 83-3143678 |
| Case Number | EO-2019130-000036 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | PHYSICIANS WORKING TOGETHER INCORPORATED |
| Organization’s Mailing Address | 1810 STADIUM DRIVE STE 210 |
| City | PHENIX CITY |
| State | AL |
| ZIP | 36867 |
| Accounting period End | 12 |
| Primary contact name | KIMBERLY A JACKSON |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
KIMBERLY JACKSON
PRESIDENT-TREASURER
1810 STADIUM DRIVE STE 210
PHENIX CITY AL 36868
Officer/Director/Trustee Two
CHRISTINA LANG
VP-SECRETARY
1441 FLORIDA AVE
MODESTO CA 95350
Officer/Director/Trustee Three
JASON HOOVER
OFFICER
5007 SUMMERVILLE ROAD
PHENIX AL 36867
Officer/Director/Trustee Four
MARIE JHIN
OFFICER
378 EL CAMINO ROAL
SAN CARLOS CA 94070
Officer/Director/Trustee Five
TANIA EDWARDS
OFFICER
7413 WHITESVILLE ROAD STE 700
COLUMBUS GA 31904
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 3/9/17 |
| Organization Incorporation State | GA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | Z99 - Unclassified |
| Organization’s purpose | Charitable: Yes Religious: No Educational: No Scientific: No Literary: No Public Safety: No Amateur Sports: No Cruelty Prevention: No |
| Qualify For Exemption | No |
| Legislation influence | No |
| Compensation of Officer director trustee | No |
| Donation of funds | No |
| Conducting Activities Outside of United States | No |
| Financial transactions with officers | No |
| Unrelated Gross Income $1,000 or More | No |
| Gaming Activity | No |
| Disaster relief assistance | No |
| One Third Support Public | Yes |
| One Third Support Gifts | No |
| Benefit of College | No |
| Private Foundation 508(e) | No |
| Seeking Retroactive Reinstatement | No |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | KIMBERLY JACKSON |
| Signature Title | PRESIDENT-TREASURER |
| Signature Date | 5/8/19 |
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